So Upset.......please Need Advice And Input!

[Need-a-Sleeve 211]

I do agree & we are probably not using the same definitions. ALL policies are a binding contract between the policy holder & insurance carrier & it pays to know exactly what you have. The only time that I know when there is no recourse is when it is a 'benefit exclusion' (not a covered benefit).

[Amanda 3.0 140]

I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

Have you talked with your primary care physician? Your regular doctor should have all sorts of medical history for you. Maybe there is some useful info in your file and your regular doctor will write a letter of recommendation. Mine did, which was the start of this process for me. I also had records of prior weight loss attempts from a diet center, Weight Watchers, etc., and even history of my primary care physician trying to help me lose weight. Think of anything at all that you can submit.

Good luck, it sounds like you will prevail on this.

[mel2643 68]

I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

[mel2643 68]

I was planning on introducing myself.... and so happy to tell everyone that my surgery date is set for Oct 8. I have done the six month supervised diet,all the preop tests everything that was required. I came home tonight and received a letter from Cigna stating at this time they do not feel there is medical necessity for this surgery and that I should send more documentation to support the necessity. I am 275 lbs 5'3,my BMI is 50 ....Really...my knees hurt,Im tired all the time,my back,feet hurt etc and oh yeah I want to live longer,be healthier,see my kids grow..Im so ready in every sense of the word for this.I have a bad feeling.I do not have diabetes or high blood pressure,so if a BMI of 50

being 275 lbs at 5'3 is not enough and not having any comorbitities (sp) Im not sure what I can do.I feel like Im going to have a fight on my hands.I mean the good news is it said this is not a denial letter,but I am just not sure what more I can send them to warrant the surgery. Please any advice is welcomed I wanna so bad join all of you on that loosers bench. I get so inspired and excited reading all of your stories on here.

[mel2643 68]

Sorry for quoting your post twice , I am replying on my nook and it doesnt seem to be app friendly on here, anyway I also received a letter from cigna stating they didnt see a medical necessity... i contacted my surgery cordinator and she worked with my pcp on a letter that stated medical necessity and i was approved , as a matter of fact I called and found out today .... do not let that letter bring you down ..... I have a sept 17 date and started my pre op liquid diet today.....